Category: Quarantine

[Image: Liberian security forces implement “a quarantine of the West Point slum, stepping up the government’s fight to stop the outbreak and unnerving residents.” Photo by Abbas Dulleh/AP, via Al Jazeera America].

Of Forcible Blockades and Military Isolation

A neighborhood-scale quarantine was forcibly imposed on the slums of Monrovia, Liberia, yesterday to help prevent the spread of Ebola.

Using makeshift roadblocks—consisting, for the most part, of old furniture, wooden pallets, and barbed wire, as everyday objects were transformed into the raw materials of a police blockade—authorities have forcibly isolated the densely populated neighborhood of West Point from the rest of the city.

Unsurprisingly, however, poor communication, over-aggressive law enforcement tactics, and general misinformation about the nature—even the very existence—of Ebola has led to local resistance.

Al Jazeera reports, for example, that “police in the Liberian capital have fired live rounds and tear gas to disperse a stone-throwing crowd trying to break an Ebola quarantine imposed on their neighborhood.” But they were perhaps simply trying to defend themselves against a badly communicated onslaught of police wielding batons and machine guns, and they would be doing so whether Ebola was in the picture or not.

Ubiquitous Quarantine

But this is only one of the most recent—and one of the more extreme—examples of the spatial practice of quarantine reappearing in the news in recent weeks. At the end of July, for example, the Chinese city of Yumen was partially quarantined due to an outbreak of bubonic plague, as parts of the city were “sealed off” from the neighborhoods around them; and the ongoing Ebola outbreak has led to involuntary quarantines being implemented at nearly every spatial level, from the individual to the city to entire international regions.

In the latter case, recall that just last week a cordon sanitaire was enforced in the international border regions of Guinea, Liberia, and Sierra Leone to stop people possibly infected with Ebola from crossing the borders. As the New York Times described this action, “The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the ‘cordon sanitaire,’ in which a line is drawn around the infected area and no one is allowed out.”

This spatial technique for managing the spread of microbiological life has “the potential to become brutal and inhumane,” the paper adds. “Centuries ago, in their most extreme form, everyone within the boundaries was left to die or survive, until the outbreak ended.”

Resisting Quarantine

Yet resistance to quarantine is nearly as ubiquitous as attempts to implement it. The very notion of involuntary quarantine is important to emphasize here: this is something that must be spatially imposed on people who have not chosen to bring this condition upon themselves.

Soldiers and police officers in riot gear blocked the roads. Even the waterfront was cordoned off, with the coast guard stopping residents from setting out in canoes. The entire neighborhood, a sprawling slum with tens of thousands of people, awoke Wednesday morning to find that it was under strict quarantine in the government’s halting fight against Ebola.

The reaction was swift and violent. Angry young men hurled rocks and stormed barbed-wire barricades, trying to break out. Soldiers repelled the surging crowd with live rounds, driving back hundreds of young men.

Involuntary quarantine can inspire this type of reaction at any scale. Consider the panic-stricken family who forcibly raided a hospital in Freetown, Sierra Leone, in order to free an Ebola-stricken relative who, they had come to believe, was being held against her will; she later died, but not before passing her infection on to others. Or consider the Nigerian nurse possibly exposed to Ebola while caring for patients who nonetheless “skipped quarantine,” either out of a desperate sense of self-preservation or due to sheer ignorance of the dangers of her actions.

“Don’t Touch The Walls!”

Somewhat incredibly, though, the deliberate breaking of quarantine can also occur not out of survivalist panic or concern for one’s own medical safety, but simply for the purpose of looting. Some of the descriptions here are jaw-dropping, with raiders actually breaking into Ebola wards to steal “property like tents, tarpaulins, buckets, hospital beds, mobile phones and shoes among other things,” literally all of which could bear traces of Ebola and thus spread the contagion elsewhere.

The New York Times had a particularly chilling example of why not to steal from Ebola wards when it ran this haunting sentence two weeks ago: “‘Don’t touch the walls!’ a Western medical technician yelled out. ‘Totally infected.'”

In a situation where even the hospitals are considered to be “death traps,” where the walls themselves are “totally infected” with Ebola, the designation of involuntary and militarily enforced quarantine boundaries is taken to mean the designation of a kind of urban sacrifice zone, a place where patients can be fatally off-loaded and the disease tragically but successfully contained. From this point of view, getting out of the quarantine zone becomes a top priority.

Residents of West Point have even protested that “their community, they believed, was becoming a dumping ground for Ebola patients,” and that quarantine was simply a spatial excuse for putting victims all in one place, uninfected neighbors be damned. “In all,” we read, “residents tried to break through the barricade three times on Wednesday, Col. Prince Johnson, the army’s brigade commander, said Wednesday evening by phone. His soldiers had fired in the air, he said, but he would not comment on whether they had also fired into the crowd.”

Powers of Quarantine

Who has the power to quarantine? Where does this power come from—especially in a Constitutional democracy like the United States—and where exactly are this power’s limits? Does it have any?

Nicola Twilley and I explored these questions last week for the New Yorker, looking at, among other things, the Constitutional implications of quarantine powers. As we point out in that piece, there is an ethically troubling overlap between the notion of the quarantined subject, spatially isolated often against his or her will, and the liminal figure of the “enemy combatant” who potentially never faces the prospect of a legal trial whilst being indefinitely detained.

In both cases, extrajudicial detention can occur on the ground of suspicion alone—presumed guilt or infection—rather than legal or medical certainty.

As we see massive international quarantine zones enforced at gunpoint throughout West Africa, and as suspected Ebola cases pop up everywhere from Johannesburg to California, it is well worth discussing where these spatial powers come from, who controls them, and when and where quarantine has reached its limit.

Confronted with widespread antibiotic resistance and increased global air travel that can bring diseases like Ebola to every global metropolis in a matter of hours, quarantine is part of “a 14th-century toolbox” that ironically looks perfectly at home in the 21st century.

Given all these examples of resistance, confusion, and the violence often necessary to impose spatial isolation on people only suspected of bearing a disease, we suggest in the New Yorker essay that quarantine becomes something of a spatial fiction, always and permanently on the verge of collapse. Its premise is a fantasy; the imaginary boundaries it seeks to defend are legally loose and physically porous.

Nonetheless, for all its apparent instability, quarantine offers a necessary fiction of separation and control at a time when the boundaries between health and contagion have become so vertiginous and blurred.

As Nicola Twilley describes these nights over on Edible Geography, “on Saturday, April 10, and Sunday, April 11, the Brooklyn-based a razor, a shiny knife team will explore the culinary implications of quarantine, preparing and serving a quarantine-themed dinner inside the exhibition itself. Tickets are not cheap but then this will not be just dinner,” she adds; it will “explore the outside limits of the science of cooking, as well as the theatrical, social, and experiential possibilities of a meal.”

Michael Cirino himself explains that “these events are not only for professional chefs or foodies; they are for anyone who loves food, regardless of culinary knowledge or experience. We produce these evenings to effect a communal environment of social interaction, education and fun.” As such, the quarantine dinners will also include live demonstrations of Cirino’s techniques—including a lesson in “interesting applications for an iSi whipper.”

I would highly recommend reading the detailed rundowns of the quarantine menu both at Edible Geography and at the event listing itself (where you can also buy tickets). Edible Geography points out, for instance, that “if the dinner guests are passengers on a journey through quarantine, then the first course plays with the idea of exposure to disease, and the second course mimics the first step taken on arrival at the lazaretto—disinfection.”

In our initial conversations, I had told Michael that during outbreaks of the Black Death in fifteenth-century Europe, port officials would “disinfect” suspect cargo and mail by dousing it in vinegar and/or subjecting it to cedar or sandalwood smoke: from that seed of an idea, combined with culinary technology, a new edible experience emerged.

There will be “vacuum-sealed plastic bags,” riffing off the idea of separation and containment, and an “encapsulated” dessert course, all prepared by Cirino using the best ingredients on offer (such as dry-aged steak from the finest purveyors in New York City, white truffles, steelhead trout roe, and specially paired wines from Cabrini).

The very idea of a quarantine menu is, I have to say, extraordinarily inspired, as it recontextualizes the spatial tactics of quarantine as unexpected new techniques for cooking, and it takes materials and foods that have themselves, at various points in history, been subject to quarantine and treats them as ingredients for a gourmet meal. Further, an elaborate dinner served and plated after-hours inside Storefront for Art and Architecture will be quite a thrill (for photos of what such a meal might look like, check out the dinner for the Storefront re-opening gala a few years back).

In any case, all proceeds go to a razor, a shiny knife, and the events sound brilliant; definitely consider supporting Cirino’s culinary experiments, as you’ll get a night of cooking demonstrations and a delicious, once-in-a-lifetime meal in the process.

He is also co-editor, with Laura B. Sivitz and Kathleen Stratton, of the 2005 report Quarantine Stations at Ports of Entry: Protecting the Public’s Health. That report consists of more than 300 pages of policy guidelines for how the United States can operate, maintain, and even expand its network of national quarantine stations. The very idea of a national quarantine policy, let alone phrases like the international “Quarantine System,” can inspire, at the extreme, all manner of conspiracy-laden theories—including the specter of fully militarized, FEMA-administered concentration camps on U.S. soil. In reality, however, “today’s quarantine stations are not stations per se, but rather small groups of individuals located at major U.S. airports. Their core mission remains similar to that of old: mitigate the risks to residents of the United States posed by infectious diseases of public health significance originating abroad.”

A jurisdictional map of CDC quarantine stations is available online, complete with informational PDFs ready for download.

As part of our ongoing series of quarantine-themed interviews, Nicola Twilley of Edible Geography and I spoke to Dr. Benjamin about the APHA’s policy recommendations for pandemic flu quarantine, about the role of eminent domain in the medically-motivated seizure of private property, and about the architectural challenge of designing dual-use facilities for public emergencies.

• • •

Edible Geography: I was interested to read the American Public Health Association’s flu policy recommendations from 2007—in particular, to see the APHA’s emphasis on mental health support for people held in quarantine. What led to that being included in your official guidelines?

Dr. Georges Benjamin: If people are going to be confined for some time within a facility, then you want to make sure that you’re identifying those people who are already being treated for mental health issues. You want to make sure they’re getting their therapy and their medications, and you want to deal with any issue that might occur when someone has to stay alone under that level of stress.

Remember that someone who is quarantined is different from someone who is isolated. Quarantined people aren’t sick; they’re people who may get sick. They’re people who have been exposed to a disease but who are not physically ill. In many cases of voluntary quarantine, people are being asked to stay at home by themselves, or to stay self-isolated, and we need to make sure that someone is paying attention to them. We want to identify people who are not able to handle being by themselves or being in a relatively confined space—even if it’s inside their own home.

We were also concerned about making sure people have the basic needs of life: food, water, access to medical care, and access to social services. You want to make sure that you’ve addressed whatever those needs might be. All of these things were part of our package for people who might be quarantined.

BLDGBLOG: Who were the specific constituencies that called for those guidelines, and did anyone try to push you in another direction?

Dr. Benjamin: These guidelines come from our members. A lot of these discussions started way back when we were talking about smallpox, rather than pandemic influenza. We were thinking seriously about the idea of having people stay at home and be isolated, if they’re ill, or quarantined should there be a terrorist attack.

No one actually has access to smallpox now, but we were going out and vaccinating people against a potential terrorist threat, anyway. So we started having these discussions around the idea of whether or not you really needed to reinstitute large-scale—primarily voluntary—quarantine. In addition, we were talking about the risk of a pandemic.

Then, as you know, Hurricane Katrina hit New Orleans. You had people there who, by virtue of the fact that they ended up in the Superdome, did not have all of the things they needed. Certainly a lot of that stuff had been planned for, but it hadn’t been done as robustly as it needed to have been—and, obviously, they had more people in there than they could take care of.

Our thinking, based on that experience in New Orleans, was: in an emergency situation, how do you make sure that people have what they need? And, quite frequently, the mental health needs of people are something that matters in every kind of large-scale public health emergency—whether that’s a tornado, a hurricane, the flu, or an event where large numbers of people have died. It’s one of those things that people don’t really think about ahead of time, unless you remind them to think about it.

Our recommendations don’t just apply, by the way, to the people who are confined; there are huge stresses on the people who are managing those events. The EMTs, the paramedics, and the public health personnel who are all actually managing things can be really challenged—and you have to pay attention to them, too.

BLDGBLOG: The APHA has also written about who exactly should have the authority to make decisions about who goes into quarantine and why. Can you talk us through your policy on that issue?

Dr. Benjamin: First of all, we try to guide by the least restrictive policy possible—and, to the extent that someone can be voluntarily in quarantine, that’s our first principle. Voluntary quarantine and the least restrictive quarantine possible is what we think is the most important way to start.

Simply giving people the facts about a disease process and keeping them well-educated and well-informed long before you’re going to need to take any action is the best policy. We, as an association, along with our colleagues in the federal agencies, have been trying to talk to the public about what the risks are for various diseases. How do you catch a disease—and how do you not catch it? How you protect yourself? How do you protect your loved ones? Usually, armed with this information, most people will follow the basic recommendations.

However, to the extent that you have to have compulsory quarantine—because you have someone who is continuing to put people at risk—then that is imposed, in the United States, by public health authorities. They have powers, mostly at the state and local level: those powers give them the authority to incentivize people not to put others—or themselves—at risk. In some cases, they can do that by having the police authorities act; in other cases, they have to go to court first. It depends on the individual jurisdiction.

In most cases, federal authorities’ powers end at the borders of the nation and then at the borders of each state. They can deal with issues across state lines, in some cases, and, of course, at our national borders and at ports of entry; but most of these quarantine authorities rest at the state and local health officer level.

BLDGBLOG: Has any of that legislation been revised in light of SARS, H1N1, or even the anthrax attacks?

Dr. Benjamin: There has been a national effort to modernize our public health laws. A lot of them were written years and years ago.

For instance, I was a state health official in Maryland from 1995 to 1999, and I was the secretary of health in Maryland from 1999 to 2002. During that time we began a process, which we finished when I was secretary, to update and modernize our laws. We had started talking about it before 9/11, but after 9/11 and the anthrax attacks , we realized that biological terrorism was a significant risk, and we really worked to strengthen the public health laws.

To give you an example of the kinds of changes and updates we made: we worked to put in some additional patient protections. The law at that time gave the health secretary enormous police powers to hold and to quarantine individuals—but there were no rights or rules for those individuals, or regulations about what they needed to receive while they were in confinement. The assumption was, of course, that they would get reasonable support and care—but we felt it was very important to guarantee that.

So we worked with several members of our advocacy community to strengthen the authority that the health officer had, and to make the authorities that I had at the time, as secretary of health, much clearer. But, on the same token, we were writing in protections. We guaranteed people due process. We guaranteed that, if we had to forcibly confine someone, then they would get medical care, social services, and social supports that they actually need. We put that in writing.

Other states around the nation have begun doing the same thing. There have been some public health law centers set up through various foundations, and they have also been working very hard to strengthen the various laws. There was a model public health law—I think it was produced with a grant from the Centers for Disease Control and several of the public health groups working with them. That law was then shared with all of the states and their elected officials, and it was used as a template through which states could look at their own laws and see how they matched up to the model.

Some states simply took the model and implemented it, exactly as it was written; some took pieces of it out; others took it and said, no, compared to the law we currently have, ours is better and we like ours. Either way, it served as a useful catalyst for people to begin looking at their own public health laws—not only in terms of the authorities that the public health officer had around isolation and quarantine, but also about reportable diseases, which diseases ought to be reported, and how, and who should do the reporting. There were also things that we added around patient protections, citizen protections, and due process. And there were sections that meant to clarify existing law, based on case law in the state, or nationally.

That work has been going on since late 2001, and it continues to this day in a variety of formats.

[Images: Hong Kong’s entire Metro Park Hotel was put under quarantine for seven days after an H1N1-positive Mexican tourist stayed there in May 2009; “psychologists were on standby,” we read. All photos courtesy of the China Post].

BLDGBLOG: In terms of these public health laws, where can quarantine occur? It was interesting during the SARS outbreak in Toronto, for instance, to see that hotel rooms were simply repurposed as temporary quarantine facilities.

Dr. Benjamin: Quarantine can occur anywhere—that’s the short answer.

Remember that quarantine is basically telling someone who has been exposed to a disease, even if they haven’t come down with that disease, to stay away from others, and to stay somewhere that we can observe them and see if they get sick. Functionally, that can occur anywhere—as long as you have the support that you need, and as long as you’re not kept somewhere where other people will be at risk. For someone who’s quarantined, a hospital is probably not a good place for them, because there are sick people in that hospital and, in any case, the hospital will usually need those beds.

Let’s say I travel to England for a business meeting, and there’s a big infectious disease outbreak. They’re not quite sure what it is, but I could theoretically have been exposed. They don’t want me to travel back home because they don’t want me on an airplane; I could expose people on that airplane. So they ask me to stay in my hotel room, and to get room service. That’s probably a perfectly reasonable request—as long as you know that, in everybody who’s had this disease, it shows up within 48-72 hours. It might be very inconvenient, but, in the interest of public health, somebody could ask me to do that. Now, there are issues around the air circulation in the hotel, and whether or not that’s appropriate—but let’s just assume that it is. From the APHA perspective, that request would be fine, particularly if you have somebody who can call and check on you a couple times a day and make sure that you’re not getting sick in the hotel room.

Now let’s say this happens at a wedding party taking place at a small hotel. For all practical purposes, if everybody at that hotel had been at the wedding, it would be reasonable to ask everybody to stay at that hotel—and, actually, they wouldn’t even have to stay in their rooms. They could be out and amongst each other, as long as they were fully informed about the symptoms that you get when you start to come down with whatever this disease process is. If those symptoms start to show, those people would then self-isolate, call public health authorities, and tell them, “I’m in my room, and I’ve got a cough and a fever, and I didn’t have that yesterday.”

If it turns out that this disease process is something mild, and we know you can take care of it there in the hotel room, then we’d probably just say, OK, isolate yourself in the hotel room. Before, you were able to get up and walk around the hotel—no big deal—but now you have to stay in your room. We’ll have the concierge send up your meals, and we’ll give you some Tylenol for your temperature. If it was something like H1N1—or some other viral illness that we knew is susceptible to antiviral agents—then we may very well give you antiviral agents, too. Of course, we’d also have the hotel doctor come up and see you. However, we would still ask you to stay in your room. That’s a voluntary isolation, now, within a quarantine facility, because you’ve been separated from everybody else.

The people who run the hotel, on the other hand, could say that they really don’t want this sick person staying in the hotel, for whatever reason. We’d then actually ask you to come out of the hotel; we’d come pick you up; and we’d take you to someplace else where people are being held and provided with medical care. At that point, you’re in isolation. It could be a hospital; it could be another facility. It could be a hotel; it could be a home. It could be anyplace where they’ve designated that as an isolation point. Again, in most cases it would be voluntary.

So it depends—these examples show that quarantine could take place anywhere, in a variety of forms.

BLDGBLOG: Things like eminent domain and the government seizure of private property—these legal issues surely play a role in quarantine guidelines?

Dr. Benjamin: You’re right—and we’ve had long discussions about those issues.

For example, let’s say we have to isolate people due to a very severe disease process. In most cases, when people are sick enough, they need to, and are willing to, go to a hospital—but one of the challenges we’ve found is that hospitals don’t want to be known as the “X-disease hospital”: the SARS hospital, the swine flu hospital, the smallpox hospital. There’s some history there—in the United States, it began with places that became known as tuberculosis sanatoriums. If the public begins to shun a place because they’re afraid of catching a disease that has somehow been associated with that hospital, then it takes that hospital out of business—even if you only have one or two cases.

We saw this during the anthrax attacks at hospitals where somebody had been exposed, in whatever way, to anthrax. Even though we know anthrax is not a contagious disease, we had patients who were very concerned—at OBGYN services, in particular. Pregnant women just wouldn’t go to that hospital. As it turns out, we only had a very few cases of anthrax, but the press got onto this, and they publicized the fact that a person with anthrax had been at this particular hospital. Then that hospital had patients who were concerned about going there. So, of course, what we had to do was get on TV ourselves and say: “No, no, you don’t need to worry about that. It’s not contagious. That’s not how you get anthrax. You can still go there; you can still deliver your baby there.” But reassuring the public is sometimes very difficult. In many cases, it’s more about fear than anything else.

The other piece of this is that, if you have a disease outbreak that is so widespread that you have lots of sick people, then it’s unlikely that you’ll have only one hospital impacted. One of the fallacies of people worrying about their hospital being the SARS hospital, or their hospital being the smallpox hospital, or the flu hospital, is that, in most cases, those diseases are so infectious that lots of cases are already in the hospital environment. They’re in the ER, in the outpatient clinics, etc. One hospital might have an intensive care unit, and the very sick patients may end up in that unit—but the other hospitals in the area will end up taking care of the outpatients. The likelihood of only one hospital being the hospital with a particular disease process, and being stigmatized because of that, is very low.

There are exceptions, of course: let’s say you’ve got a research hospital and it has a novel therapy, and the only way to get that novel therapy is by going there—well, that hospital is going to end up with a disproportionate number of those patients. That’s one of the communication issues that hospital is going to have to manage with the public.

Now, to your question, many of the public health laws do have statutes that allow for the taking of stuff. In Maryland, for example, the state can confiscate your facility—and it’s not just your facility: it could be your pharmaceuticals; it could be your box of syringes. If the state declares an emergency, and it has the authority of the law and it goes through the proper procedures, then, yes, it can confiscate things.

But what we did in Maryland was we clarified a few things: firstly, that you would be compensated. We thought that was very important to put in. We also wanted to make sure that it requires extraordinary efforts to make it happen. In Maryland, for instance, a disaster has to be declared by the governor, and there’s a legal process that one has to go through in order to confiscate someone’s stuff.

A lot of the plans in the U.S. for where we’ll put sick people raise some interesting issues. For example, some of these plans say that if we need to expand bed-space beyond the hospitals, then we need to use schools, gymnasiums—anyplace where you have a wide-open ward. Of course, there’s a big debate going on about whether those are the best places for these folks—and the reason for that debate is that they’re not built as health facilities. You couldn’t put your sickest people there. You might be able to quarantine people there—people who are well enough to get up and wash their hands and go to the bathroom, etc.—and you might be able to put people there who are moderately ill, but you couldn’t put very sick people there. It’s simply not set up as an intensive care unit.

The other thing to remember is that, even though you’ve got a disease outbreak going through your community, you still have the other, baseline disease processes. There are still heart attacks and strokes and people with seizures and kids with fever unrelated to the flu or unrelated to the infectious disease going on. You still need beds for people at ICUs for heart attacks, and you still have to treat cancer. The management challenge is to make sure that local providers don’t set up a process, of either isolation or quarantine, that deprives them of the resources they need to maintain their ongoing health system.

Edible Geography: Where are the gaps, as you see it, in public preparations for quarantine?

Dr. Benjamin: There are a couple of things I can think of right away. There’s the public education aspect that we and our colleagues are continuing to work on—there’s always more that could be done there.

The other thing is that we need buildings and facilities that have multiple uses. When you build hospital emergency rooms, for example—and it’s been fascinating watching this shift occur—we’ve gone from a situation where people had individual rooms in the ER to open-bed concepts. But what you need is flexibility. You need facilities flexible enough to accommodate multiple purposes.

You remember I talked about a gym being utilized as a potential quarantine spot? Well, some of the issues that get in the way of that are that there are not enough electrical outlets. You can’t bring up walls to partition the place in a way that easily allows you to isolate one group and quarantine another. There also isn’t the plumbing, and there probably aren’t enough bathrooms. You’ve put a lot of people together who may have a disease—and now you have a problem, because not everybody can wash their hands. We’re all using hand sanitizers today, and they’re wonderful, and they work; but, frankly, good old soap and hot water is the best thing to use.

Then again, most elementary schools were designed for little people, and now you’re about to put a bunch of adults in there; they might not have as many soap dispensers as you need, or the bathrooms are too large, or the toilets are too low, or there aren’t enough sinks. Or, again, maybe the sinks aren’t in the right place: they’re not by the bedside where infection-control needs to occur.

Building an environment that thinks about these other potential uses is extremely important, for places like hotels or gyms or the other big spaces that might be used to hold a bunch of people. And, by the way, quarantine is only one need for those things: as part of our overall public health preparedness, we have to look at putting people up because of a hurricane, or floods, or a tornado, or a big infectious outbreak.

The single-center principle means that a place needs to be flexible enough for large numbers of people, and in which you can have adequate infection-control, adequate toilet facilities, and adequate food facilities so that everyone can eat.

If we build places that do those kinds of things, then they’ll meet all the needs for isolation, all the needs for quarantine, and all the needs for housing people in an emergency.

BLDGBLOG: That actually reminds me of some stadiums in Japan that were built both as sports stadiums and as earthquake-disaster centers. There’s food and water stockpiled in the basement, the entryways are sized for emergency vehicles, and so on. How would you recommend this sort of architectural adaptation, on a policy level?

Dr. Benjamin: We wouldn’t have much trouble convincing the presidents of universities today, who are already challenged with a disease process big enough to affect the whole student body. In the United States right now, with H1N1, the number of sick kids is big enough that they’re having to manage those kids on campus. For a disease process in which people are going to be sick for five or seven days, it’s unrealistic to send them home once they’ve shown up on campus. Colleges are having to deal with accommodating them right now. You can bet that, at least on college campuses in the United States, they would be very sensitive to this idea of dual-use facilities, because there’s an operational need for it.

The second thing is, if I was trying to do this, I would be working directly with architects and engineers, convincing them of the need to do it and then letting them sell it. They can say how best to do this, in a way that does not obstruct the primary purpose of the facility. We don’t want to interrupt anyone’s football games, but at the moment, everyone says, yes, we can put people here but it’s only going to happen once or twice in my lifetime, when the truth is that, if you design it that way, then you could use it much more frequently for that purpose. You could get dual-use out of it. Getting the people who design these places to tell us how to do it, in an appropriate and cost-efficient manner, and then having them make the case to the owners and users, so that they know that this is value added to their facility: that’s how I would get this message across.

Then I would talk to elected city and state officials about ways they could leverage tax-payer dollars to get these dual-use facilities built. Let’s say I’m in city government and I have someone coming up to me wanting the city to put up tax-payer dollars to support the building of a football stadium or a basketball stadium or a new school. If I get this additional bonus—this dual-use that helps my emergency-preparedness—I’m more likely to want to use taxpayer dollars to support it. Increasingly, as you know, private sector guys are coming to the government and asking for fiscal support to build these facilities. If tax-payers are going to be paying for things, then the city or the community needs to get something out of it.

I can tell you that a lot of work had to be done to fix and clean the New Orleans Superdome—but if you had built it so that it could be much more functional in an emergency situation then you would have had less damage. And from an image perspective, a dual-use sports facility now has much more of a public value.

That’s my personal view, not the Association’s view; but I think it’s an effective argument.

• • •

This autumn in New York City, Edible Geography and BLDGBLOG have teamed up to lead an 8-week design studio focusing on the spatial implications of quarantine; you can read more about it here. For our studio participants, we have been assembling a coursepack full of original content and interviews—but we decided that we should make this material available to everyone so that even those people who are not in New York City, and not enrolled in the quarantine studio, can follow along, offer commentary, and even be inspired to pursue projects of their own.

What does a town under quarantine—walled off against the world, shutting its doors against commerce—feel like? What if those doors have been forcibly shut, against the citizens’ will? What is it like to be medically captive in a city? At the very least, how does one pass the time?

Nearly two years ago, while living and working in San Francisco, I would often spend my lunch breaks down at Stacey’s, an amazing bookstore that sadly went out of business this past spring. One of the books that I gravitated toward—and eventually purchased—was The Plague by Albert Camus.

Camus’s novel—about a quarantined city in North Africa called Oran, where the bubonic plague has erupted, originating in rats that have come crawling out into the streets to die en masse—seems to illustrate quite well the proposition that fiction is an extraordinarily effective medium through which to describe architectural and urban experiences. One of Camus’s characters, for instance, surveys the quarantined city laid out before him: “At that moment he had a preternaturally vivid awareness of the town stretched out below, a victim world secluded and apart, and of the groans of agony stifled in its darkness.”

Quarantine, Camus suggests, can have the effect of heightening the sensorial impact of certain urban details: “For in the heat and stillness, and for the troubled hearts of our townsfolk, anything, even the least sound, had a heightened significance. The varying aspects of the sky, the very smells rising from the soil that mark each change of season, were taken notice of for the first time.” The city has become amplified, so to speak, by its isolation. We even read that a “new paper has been launched: the Plague Chronicle,” as if all of these newly noticed details, and the alterations in daily routine that revealed them, were too numerous—and far too extraordinary—not to catalog.

But the city looms, stripped of vitality, anemic, its purpose gone; it is urbanism as depicted by Giorgio de Chirico.

The silent city was no more than an assemblage of huge, inert cubes, between which only the mute effigies of great men, carapaced in bronze, with their blank stone or metal faces, conjured up a sorry semblance of what the man had been. In lifeless squares and avenues these tawdry idols lorded it under the lowering sky; stolid monsters that might have personified the rule of immobility imposed on us, or, anyhow, its final aspect, that of a defunct city in which plague, stone, and darkness had effectively silenced every voice.

I won’t review the book here; it is worth reading, even if it’s emotionally imperfect, so to speak (and often a bit boring), but its literary merits are not what I’m concerned with. I’m concerned with its descriptions of space.

I thought, then, especially in light of the quarantine studio that kicks off in NYC this autumn, I would simply excerpt some of Camus’s more memorable thoughts on quarantine.

For instance, he writes, describing this strange state of medical siege-urbanism:

At first the fact of being cut off from the outside world was accepted with a more or less good grace, much as people would have put up with any other temporary inconvenience that interfered with only a few of their habits. But, now they had abruptly become aware that they were undergoing a sort of incarceration under that blue dome of sky, already beginning to sizzle in the fires of summer, they had a vague sensation that their whole lives were threatened by the present turn of events, this feeling of being locked in like criminals prompted them sometimes to foolhardy acts.

Oran, Camus continues, its city gates closed against foreign visitors, its citizens often sitting there, listless in the desert heat, “assumed a novel appearance.”

You saw more pedestrians, and in the slack hours numbers of people, reduced to idleness because shops and a good many offices were closed, crowded the streets and cafés. For the present they were not unemployed; merely on holiday. So it was that on fine days, toward three in the afternoon, Oran brought to mind a city where public rejoicings are in progress, shops are shut, and traffic is stopped to give a merry-making populace the freedom of the streets.

What is there to do in quarantine? Not much, it seems:

So now he drifted aimlessly from café to café. In the mornings he would sit on the terrace of one of them and read a newspaper in the hope of finding some indication that the epidemic was on the wane. He would gaze at the faces of the passers-by, often turning away disgustedly from their look of unrelieved gloom, and after reading for the nth time the shopsigns on the other side of the street, the advertisements of popular drinks that were no longer procurable, would rise and walk again at random in the yellow streets. Thus he killed time till nightfall, moving about the town and stopping now and again at a café or restaurant.

This level of ennui—”You could see them at street corners, in cafes or friends’ houses, listless, indifferent, and looking so bored that, because of them, the whole town seemed like a railway waiting-room”—unsurprisingly soon breeds violence (and, with it, glimpses of a new constitutional order):

It was incidents of this sort that compelled the authorities to declare martial law and enforce the regulations deriving from it. Two looters were shot, but we may doubt if this made much impression on the others; with so many deaths taking place every day, these two executions went unheeded—a mere drop in the ocean. Actually scenes of this kind continued to take place fairly often, without the authorities’ making even a show of intervening. The only regulation that seemed to have some effect on the populace was the establishment of a curfew hour. From eleven onwards, plunged in complete darkness, Oran seemed a huge necropolis.

For all of these descriptions, however, the question remains: what is the effect of quarantine on a city’s populace? Can public policy reach down into the emotions of a resident and predict how he or she might react? And how is urbanism itself transformed by states of temporary—but enforced—isolation?

For that, a much larger conversation about quarantine and the city must ensue.

[Image: Quarantine facility and hospital ward on Swinburne Island, in the NYC archipelago].

It’s been an extremely eventful month since Edible Geography and BLDGBLOG teamed up to announce “Landscapes of Quarantine,” an eight-week, intensive, independent design studio to be hosted this fall in New York City; its brief is to create original and thought-provoking design projects that explore the spatial implications of quarantine. The results of the studio will then be the subject of an exhibition at Storefront for Art and Architecture in spring 2010.

The practice of quarantine extends far beyond questions of epidemic control and pest containment strategies to touch on urban planning, geopolitics, international trade, ethics, immigration, and more. In the early twentieth century, for example, “quarantine lines in Africa offered a clear and politically useful demarcation for new ‘international’ borders between Sudan and Egypt,” as historian Alison Bashford points out in her book Medicine at the Border.

From Boccaccio’s Decameron and disinfected mail protocols to bio-secure airlocks, plant smuggling, and Matt Leacock’s Pandemic boardgame, quarantine is a fertile territory for architects and designers to explore.

Over the past few weeks, we have been blown away by the quality (and even quantity) of applicants interested in the studio. Indeed, narrowing the pool down to a manageable group of participants has been a very tricky process. We have been concerned all along with achieving a usefully diverse mix of backgrounds, media, and individual strategies of approach, while holding numbers low enough that the studio can still function as a weekly discussion group.

[Image: U.S. “Federal and State Isolation and Quarantine Authority,” updated January 18, 2005].

Joe Alterio is an illustrator, animator, comic creator, and artist, interested in narrative structure, collective creativity, and the physical manifestations of story-telling. Joe has been at the forefront on using new technology to push forward the graphic narrative medium, from his early 2004 mobile comic The Basic Virus to his most recent work with Robots and Monsters. Alterio’s work has appeared in the Boston Globe, Rolling Stone, Boing Boing, Drawn!, The BLDGBLOG Book, and many other publications.

Elizabeth Ellsworth and Jamie Kruse are co-directors of smudge studio, a collaborative, non-profit media arts studio based in Brooklyn. Ellsworth is Associate Provost of Curriculum and Learning and Professor of Media Studies at The New School. Her recent book, Places of Learning: Media, Architecture, Pedagogy is about the aesthetics of mediated learning environments. Kruse is an artist, independent scholar, and freelance graphic designer.

Scott Geiger is the recipient of a Pushcart Prize for fiction. A contributor to magazines such as The Believer and Conjunctions, Geiger also writes for Architecture Research Office, a 2009 Finalist for the National Design Award for Architecture. As a Cleveland native, schemes to rescue America’s postindustrial cities stalk his work.

Yen Ha and Michi Yanagishita are principals of Front Studio Architects, named one of the “world’s 50 hottest young architectural practices” by Wallpaper magazine. Their work has been featured internationally in Icon, AD: Cities of Dispersal, and the New York Times, and it was recently featured in the London Yields exhibition at the Building Centre in London. The Invisible Gate, their competition entry in the 2005 Gdansk International Outdoor Art Gallery, is currently under construction.

Katie Holten has exhibited widely in Europe and the United States, and, in 2003, she represented Ireland at the Venice Biennale. She currently has a solo exhibition at The Bronx Museum of the Arts and a public artwork installed in the Bronx, called the Tree Museum. Holten was born in Dublin, Ireland, and is now based in New York City.

Jeffrey Inaba is the Director of C-Lab, an architecture, policy and communications think tank at Columbia University‘s GSAPP, and he is Features Editor of Volume Magazine. With Rem Koolhaas, Inaba co-directed the Harvard Project on the City, a research program investigating contemporary urbanism and planning worldwide. Before starting INABA, he was a principal of AMO, the research consultancy founded by Koolhaas. Inaba has also taught at UCLA, Harvard, and SCI-Arc, and he lectures worldwide.

Ed Keller is a designer, professor, writer, “media architect,” and former professional rock climber. He is co-founder with Carla Leitao of AUM Studio, an architecture and new media firm based in New York and Lisbon. Keller is an Associate Professor at Parsons School of Design, and he has taught at Columbia’s GSAPP, SCI-Arc, Pratt, the University of Pennsylvania, and more. Keller’s work has been featured in ANY, AD, Wired, Metropolis, Assemblage, among others.

Mimi Lien is a designer of sets and environments for theater, dance, and opera. After studying architecture at Yale University, she began making paintings, installations, objects, and designs for performance. Her work has been seen at The Joyce and The Kitchen, and she is a recipient of a 2007-2009 NEA/TCG Career Development Program award.

Richard Mosse is an Irish photographer based in New York. He travels extensively with the assistance of a Leonore Annenberg Fellowship in the Performing and Visual Arts. Recent forays have taken him to Gaza, the Yukon Territories, and Iraq. Mosse has a forthcoming solo show at Jack Shainman Gallery, opening on November 19th, and new video work will be exhibited at Barcelona’s Ca L’Arenas, in a year-long exhibition cycle, investigating war and its representations.

Daniel Perlin is a New York-based artist and sound designer. Perlin operates across media, creating video, objects, installations and performances. His work has been heard at Chelsea Art Museum, the Whitney Biennial 2006, D’Amelio Terras, TN Probe Tokyo, Temporary Contemporary Gallery, the Centre Pompidou, and BCA (Beijing), as well as in such films as Kelly Reichardt’s Old Joy, Errol Morris’s Fog Of War and Phil Morrison’s Junebug.

Thomas Pollman is an architect and amateur cartographer based in New York City. He currently works in the Geographic Information Systems Division at the NYC Office of Emergency Management, where he works to enhance situational awareness for first responders through the deployment of geospatial technologies. Pollman is a registered architect in the State of New York.

Kevin Slavin is managing director and co-founder of Area/Code. Working with media companies, museums, brands, and foundations around the world, Area/Code focuses on games with computers in them. Their work frequently extends game systems into the real world—and the other way around. Prior to founding Area/Code, Slavin was an artist and an advertising executive.

Brian Slocum is the recipient of a 2008 grant from the New York State Council on the Arts for ad hoc infrastructures, a design research project focusing on the deployment of scaffolding and alternatives for its spatial exploitation. Slocum was a contributor to Pamphlet Architecture #23 and is currently an Associate at Polshek Partnership Architects.

Amanda Spielman is a graphic designer at SpotCo, a New York-based design studio and ad agency that specializes in creating artwork for Broadway theater. Previously, she spent seven years in editorial design. Her work has appeared in The Design Entrepreneur, Fingerprint, Graphis, STEP, SPD, and metropolismag.com. Spielman graduated from the MFA Design program at the School of Visual Arts, and holds a BA from Vassar College.

Lebbeus Woods is an architect and educator. He is co-founder of RIEA.ch, an institute devoted to the advancement of experimental architectural thought and practice, and author of Pamphlet Architecture #6 and #15, among countless other articles and books. His works are held in private and public collections worldwide, including the Museum of Modern Art and the Austrian Museum of Applied Arts, Vienna. Woods has received the Progressive Architecture Award for Design Research, the American Institute of Architects Award for Design, and the Chrysler Award for Innovation in Design. He is currently Professor of Architecture at The Cooper Union in New York City.

It’s hard to overstate how honored we are to work with practitioners of this caliber; we look forward to eight solid weeks of inspiring conversations and even more interesting work.

Expect frequent updates throughout the fall – in particular, during the week of October 5th, when we will begin to publish, both on Edible Geography and on BLDGBLOG, a series of original interviews with quarantine historians, public health policy experts, biosafety consultants, and more, placing quarantine into its unpredictably extensive context.

By making the studio discussions and our own research material public, we hope that anyone who has been inspired by the studio brief – and by the subject matter of quarantine – will be inspired to pursue their own projects, outside the necessarily limited walls of the studio.

I’m incredibly excited to announce not only that BLDGBLOG will be living in New York City this fall, but that my wife and I will be hosting a design studio there called Landscapes of Quarantine – the results of which will be the subject of a public exhibition at Storefront for Art and Architecture in early 2010.

Meeting one evening a week this autumn in Manhattan, from October 6 to December 5, 2009, up to 14 studio participants will discuss the spatial implications of quarantine, each developing an individual design project in response to the studio theme.

Quarantine is both an ancient spatial practice and a state of monitored isolation, dating back at least to the Black Death – if not to Christ’s 40 daysin the desert – yet it has re-emerged today as an issue of urgent biological, political, and even architectural importance in an era of global tourism and flu pandemics.

Quarantine touches on serious constitutional issues associated with involuntary medical isolation, as well as on questions of governmental authority, regional jurisdiction, and the limits of inter-state cooperation. Quarantine is as much a matter of national security, public safety, and agricultural biodiversity as it is an entry point into discussions of race, purity, and unacknowledged discrimination.

Quarantine is also a plot device increasingly seen in novels and films – from the aptly named Quarantine and Albert Camus’s The Plague to I Am Legend and The Last Town on Earth – even as it has become a source of arcane technical debate within plans for Martian exploration and Antarctic drilling rights.

The design implications of quarantine stretch from the ballast water of ships to the way we shape our cities, from the clothes in travelers’ suitcases to stray seeds stuck in the boot treads of hikers. Quarantine affects the pets we keep, the programs we download, and the machines we use in food-processing warehouses, worldwide.

Quarantine is about managing perimeters, controlling influence, and stopping contamination.

[Image: Cages for the laboratory testing of rats and mice by Innovive].

So how do we treat quarantine as a design problem?

Whether we design something to demonstrate that the very notion of quarantine might not be possible; whether we produce actionable plans for quarantine units, ready for implementation by the World Health Organization in hot zones around the world; whether we create quarantine-themed graphic novels, barrier-based urban games, or a series of ironic public health posters to be mounted around the city, how can we design for quarantine?

Quarantine also offers fertile territory for investigation through cartography and cultural documentation. After all, if we mapped the contents and locations of quarantine facilities worldwide, designed infographics to analyze the spread of invasive species, or recorded the oral histories of the quarantined, what sorts of issues might we uncover?

Bringing these very different techniques, media, and approaches together in the confines of a dedicated design studio will give participants an exciting opportunity to explore the overlooked spatial implications of quarantine.

We have already confirmed a fantastic list of participants, whose backgrounds include architecture, photography, illustration, games design, sound, landscape, food, and more; we are now opening the studio to a general call for interested participants.

The brief – which you can download here as a PDF or that you read as a JPG on Flickr – explains more; but potential applicants will be working with a truly stellar group as they meet once a week this fall and produce work eligible for inclusion in the “Landscapes of Quarantine” exhibition to be held at Storefront for Art and Architecture in early 2010.

If you are interested, please download the brief – which includes all necessary application info – and contact us at futureplural @ gmail by September 19, 2009.

For ease of reference, I have decided to include the studio brief in full below:

Landscapes of Quarantine is an independent, multi-disciplinary design studio, based in New York City, consisting of eight Tuesday evening workshops, from October 6 to December 5, 2009, in which up to 14 participants will gather to discuss the spatial implications of quarantine. Quarantine is an ancient spatial practice characterized by a state of enforced immobility, decontamination, and sequestration; yet it is increasingly relevant—and difficult to monitor—in an era of global trade, bio-engineering, and mass tourism.

During the studio, participants will develop individual design projects in response to the problem of quarantine, with guidance and inspiration provided by readings, screenings, group discussions, and an evolving line-up of guest speakers and critics. These projects will then be eligible for inclusion in “Landscapes of Quarantine,” an exhibition hosted by the internationally renowned Storefront for Art and Architecture in early 2010.

By the end of the studio, each participant will have produced a complete design project. This could range from the speculative (plug-in biosecurity rooms for the American suburbs) to the documentary (recording the items and animals detained for quarantine on the U.S./Mexico border), and from the fantastical (plans for extra-planetary quarantine facilities) to the instructional (a field guide to invasive species control).

Landscapes of Quarantine is looking for applicants who are intrigued by the spatial possibilities and contingencies of quarantine, and who already possess the technical skills necessary to produce an exhibition-quality final design project or installation in their chosen medium. We hope to hear from people at all stages of their careers—from graduate school to retirees—and from a wide variety of design backgrounds. We are particularly excited to announce that we have already confirmed a select group of talented participants from fields as diverse as architecture, illustration, gaming, photography, and sound design.

The studio is both unaffiliated and independent (there is no college credit), and it is also free (though applicants will be responsible for all costs associated with producing their final project). We will be reviewing applications on a rolling basis until Friday, September 18, 2009, or until all studio positions have been filled. To learn more, and to submit an application, please email futureplural @ gmail with the information listed below.

1) Name2) Email address3) Telephone number(s) Please indicate the best time to reach you4) Mailing address5) Education• University/college name and country• Dates attended• Degree 6) Current affiliations and/or employment7) 50-word (maximum) bio8) Publications and/or personal blog 9) PortfolioAttach a PDF of no more than 8 pages, or supply a link to online work10) 300-word (maximum) statement of interest in the topic of quarantine11) Candidate’s declarationBy submitting your application, you declare the following:• I certify that the work submitted is entirely my own and/or my role is clearly stated• I declare that all the statements I have provided are correct• I agree that, if accepted into the studio, I will participate fully, attend all studio meetings unless previously discussed with the studio directors, and produce a finished final design project12) Email addresses for two references

Landscapes of Quarantine is produced and organized by Future Plural, a project-based, independent design lab launching in October 2009 from a temporary base in New York City. Future Plural is Geoff Manaugh (BLDGBLOG) and Nicola Twilley (Edible Geography).

Finally, a major motivation behind starting Future Plural and hosting the Landscapes of Quarantine studio is to found a new institution without permanent location, dependence on grants, or academic affiliation. After all, as bloggers, why can’t we create our own groups, faculties, cultural spaces, and more? By bringing people together, on a project-by-project basis, to explore ideas and issues in a cross-disciplinary environment, we hope to demonstrate that, even in a time of recession, there is a broadly shared enthusiasm for creating something new.